1. Field of the Invention
This invention relates to surgical procedures and apparatus utilized in arthroscopic surgical procedures for knee reconstructive surgery utilizing a drill guiding device for drilling a hole from the medial or lateral side of the knee to intersect a straight ligament tunnel for passing a fastener device to engage and endosteally mount a bone end of a bone tendon bone or other type of ligament graft in position in the ligament tunnel.
2. Prior Art
The invention is for use in an anterior or posterior cruciate ligament repair and replacement surgical procedure where tibial and femoral tunnel sections are formed to pass through the ligament points of origin in the knee, the tunnel sections for containing a ligament spanning the knee intra articular joint. With the knee bent to approximately ninety (90) degrees, the tibial and femoral tunnel sections form approximately a straight tunnel, facilitating fitting a ligament end into the femoral tunnel section. To provide a set screw, interference, or transverse pin type mounting of an end of a ligament graft in a either the femoral or tibial tunnel sections, a drill guide is utilized to form a transverse passage or hole that intersects a femoral and/or tibial tunnel section. Drill guides appropriate for use in providing this transverse drilling are shown in earlier U.S. patents of the inventor, U.S. Pat. Nos 4,901,711, 4,985,032 and 5,152,764, and in a U.S. Patent Application for a Multiple Guide Sleeve Drill Guide, U.S. Ser. No. 07/930,273. These drill guides each provide for drilling, from a guide sleeve device fitted to an external drill guide rod or leg, a straight hole or tunnel to intersect a target point on a drill guide reference rod or leg that is seated within the tunnel. An additional drill guide of the present inventor, identified as a "Sight Barrel Arthroscopic Instrument", U.S. patent application Ser. No. 07/580,172, is preferred for use in the invention for forming a transverse hole from within the knee to intersect, at an acute angle, a single point along a tunnel section, or points along both femoral and tibial tunnel sections.
The above cited drill guides of the inventor all reference the aligned tibial and femoral tunnel sections utilizing a reference rod that is fitted into the straight ligament tunnel. A practice of the method of the present invention utilizes a drill guide to drill from an external rod to a target on the reference rod, which drilling is accomplished utilizing a drill that includes indices scribed therealong for determining the exact distance from the side of the patent's knee to the ligament tunnel wall. Which measure is use to select an appropriate length of fastener device for seating in a ligament position in the ligament tunnel. Further unique to the invention, after drilling a transverse hole or passage to the ligament tunnel, the drill guide is replaced with a soft tissue guide for maintaining hole or passage location and to allow for twist drill replacement with a K-wire. The K-wire or, alternatively, the twist drill that was used with the drill guide to drill the transverse hole, doubling as a guide, is then used for guiding turning of a second twist drill therealong. The second twist drill provides for enlargement of the transverse hole and for guiding a cannulated screw or set screw fitted into the transverse hole that, depending upon placement, functions as a set, cross or interference screw, for securing a bone end of a bone tendon bone ligament graft, or other ligament graft, in the femoral ligament tunnel. The cannulated set screw can guide passage of a cross pin to pass through the ligament, providing additional purchase for mounting a bone tendon bone ligament graft, or can be utilized for fitting through a loop of a soft tissue graft that has been fitted into the femoral tunnel section. The cannulated set screw can also serve as a mount for a cleated washer that, when the set screw is turned into the tunnel section, guides the washer cleats into the side of a soft tissue graft fitted therein, urging it against the opposite tunnel wall.
The present process preferably utilizes a drill guide, like those set out above, for forming a transverse passage or hole that intersects a ligament mounting tunnel. While other drill guides have been utilized in arthroscopic surgical procedures, such have provided for drilling, from without the knee, to a locator point within the knee intra articular joint, rather than to a point within a ligament tunnel. Examples of such earlier devices are shown in patents to Walt, et al, U.S. Pat. No. 4,920,958; to Sapega, et al, U.S. Pat. No. 4,739,751; to Cho, U.S. Pat. No. 4,257,411; to Hourahane, et al, U.S. Pat. No. 4,535,768; to Hourahane, et al, U.S. Pat. No. 4,672,957; and a United Kingdom patent to Lovell, et al, No. 2,078,528. Also, other devices for drilling tibial and femoral tunnel sections are shown in patents to Odensten, et al, U.S. Pat. No. 4,823,780; Seedholm, et al, U.S. Pat. No. 4,668,233; and a European patent application No. 0126520. None of which patents, however, provide an arrangement that is suitable for practicing the method of the invention.